Duodecim; lääketieteellinen aikakauskirja
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Key findings and recommendations from a study comparing clinical research regulation in Finland with those in England, Canada (Ontario) and USA are presented. Data were collected with various methods, including interviewing key experts. ⋯ Research ethics committees (REC) were crucial, as well as drug authorities in research with drugs. Recommendations include reforming the medical research law, widening the dimensions of ethics judgment, restricting the REC tasks, including a central committee, and introducing quality assurance and restricting the drug control authority tasks.
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Amyotrophic lateral sclerosis (ALS) is a disease causing degeneration of motor neurons, without any curative treatment. The most common cause of death is respiratory arrest due to atrophy of the respiratory musculature. ALS-associated respiratory insufficiency differs in mechanism from the more common causes of dyspnea, such as diseases of pulmonary or cardiac origin. ⋯ It should be possible to predict the development of respiratory insufficiency in order to avoid leaving the treatment decisions concerning respiratory insufficiency to emergency services. Noninvasive ventilatory support can be used to alleviate the patient's dyspnea. It is actually recommended as the first-line treatment of ALS-associated respiratory insufficiency.
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Although anesthetic monitoring has rapidly developed over the past few years, accidental awareness during general anesthesia still remains a significant clinical problem. It occurs in one out of thousand surgical patients. In addition to conventional clinical signs, the adequacy of anesthesia can be assessed for instance by monitoring the changes occurring in the electroencephalogram (EEG). The EEG effects of different anesthetics are, however, highly varied, and attempts to develop an unequivocal neurophysiological measure or quantity for human consciousness or unconsciousness have so far been unsuccessful.
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Glycocalyx consisting of proteins and carbohydrates is lining the complete healthy vascular endothelium. Being in continuous interaction with plasma proteins and other plasma components, the glycocalyx forms an endothelial surface layer playing an important role as protective mechanism of the vascular wall, in blood coagulation and regulation of permeability. ⋯ The extent of tissue swelling is also connected with morbidity and mortality. The question about the volume effect of infusion solutions and, on the other hand, prevention of permeability disturbance still remains highly actual.
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Hoarding is a mental disorder having its onset at young age and often worsening with age, manifested as a need of storing up goods to an extent that significantly hampers everyday life. In the light of conducted studies, at least 1 to 2% of the adult population suffers from hoarding. ⋯ Hoarding differs from obsessive-compulsive disorder in its course and treatment response. Treatment of hoarding disorder is based on methods applied in cognitive behavior therapy.